Myocardial infarction and denial.

Denial, a natural defense mechanism, can be either an appropriate or an inappropriate response to anginal pain. Myocardial infarction sufferers often delay several hours before seeking medical attention, and most deaths from infarction occur before hospitalization. These two facts indicate that denial may contribute to mortality from coronary artery disease. To encourage "stoical" patients to seek medical care, nonthreatening educational approaches to cardiac disease and concentrated efforts to reduce anxiety toward hospitals are needed. Family physicians knowledgeable about the effects of denial can screen cardiac-prone patients for inappropriate denial and alter diagnostic approaches in an attempt to lessen the role denial plays in cardiac deaths.